caring for the elders and their caregivers

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  1. What is home?
    • shelter
    • a place where one belongs
    • security
    • high level of functioning
    • high level of functioning
    • independence
    • a level achievement
    • celebration of one's sense of pride (self- actualization)
  2. Goal of elder living
    • to live independently and adapt their environment (home and community) to meet their needs
    • elders prefer to age in place...where they are familiar with, accomodate as long as safety is maintain
  3. Residential care options
    • Older adult- friendly communities will:
    • - address basic needs: affordable housing, food, safety
    • - optimized health and wellness: access to preventive, medical health services, social services
    • - Maximize independence for the frail and disabled: accessible transporation, supports family
    • - provide social and civic engagement: meaningful connections with family, friends. active engagement with community
  4. Interventions that enhance elder friendly communities
    • adequate transportation system
    • home modification
    • barrier free housing
    • - wider doors and hallways
    • - bathroom on the first floor
    • - outlets at wheelchair level
    • - reinforced walls for support bars, chairs in the shower
    • - no step entry
  5. Models of housing for older adults
    • Family housing
    • - multigenerational- 3 fam housing (granny flats, in law apt
    • shared house- opening personal home to others
    • population- specific communities (expenses can buy into this)
    • - supports specific lifestyles ie golf tennis
    • senior retirement communities
    • - communities with additional services ie restaurants, housekeeping, security etch
  6. US department of housing and urban development (HUD)
    provides federal subsidized low rent housing in senior retirement homes for elders with limited incomes
  7. Community Based care
    • community based care settings include:
    • 1. homes care services- CNA housekeeping
    • 2. Adults day care services
    • - group programs provide supervision, socialization
    • - respite for caregivers
  8. Community based care cont 3
    • 2. residential care facilities
    • - Assisted living facilities
    • Advantages:
    • - less expensive than skilled nursing homes
    • - more home like
    • - more independence
    • - more privacy
    • - cost 3300-7000 depending on the community and location
    • Disadvantages:
    • - no organized team of providers
    • - extra services can be brought in but extra money
    • Continuing care retirement communities
    • - full range of residential options-- skilled nursing to single family homes
    • - may transition to different levels without disrupting moves
  9. Program for All Inclusive care for the Elderly (PACE)
    • recognized as evidence based model of care by the us dept of health and human services
    • belief that is is better for the wellbeing of seniors with chronic care needs and their families to be served in the community whenever possible
    • PACE enables frail elders to live in the community as independently as possible by providing preventative
  10. PACE
    • PACE has a capitated system
    • - all services are paid for in one monthly sum
    • - Providers can respond to the unique needs of the elder
    • Individuals must:
    • - meet the criteria for the nursing home administration
    • - prefer to stay in the community
    • - eligible for medicare, medicaid
  11. Other care setting
    • Acute care setting: those that have chronic illness or co mordities are usually here
    • Nursing home: long tern care
    • Skilled nursing facilities:
    • - provides post acute care after hospitalization
    • - must have access to rehab and restorative care services to improve function
    • - medicare pays for the first 20 days and then 80% for the next 21-80 days
  12. Cost of care in a nursing home facility
    • The average cost is 215 per a day, 78,475 annually
    • care is paid thru:
    • - medicaid 42%
    • - medicare 25%
    • - out of pocket 22%
    • - private insurance and other income
    • Assisted living facilities:
    • - residential long term care for those who are more independent
    • - they do not need 24 hour home skilled nursing
    • - may need assistance with some ADL
    • - meals and laundry services are provided, house cleaning
  13. profile of person in assisted living
    • need help with more than two ADL's
    • - bathing
    • - dressing
    • - eating
    • - transferring
    • - toileting
    • they move into ALF from home
    • a certain % end up going into a nursing
    • some residents die there
    • meal prepration
    • medication
    • some have alziemhers and dementia
    • usually around 86.9 and usually women
  14. Quality of care in facilities
    • Omnibus Reconcilation Act (OBRA) 1987
    • - frequent updates and revision
  15. Highlights of the omnibus reconcilation act (OBRA)
    • MDS miminum data sets- comprehensive assessment done on admission and then quarterly
    • increased CNA training
    • eliminate use of medications and restraints for discipline
    • attempt to reduce or eliminate antipsychotic
    • staffing requirements 24 hr
    • quality assurance
  16. Established regulations OBRA
    • residents rights
    • admission, transfer and discharge rights
    • residents behaviors and facility practices
    • quality of life - promoting this
    • nursing services
    • specialized rehabilation services
    • dental service
    • pharmacology services
    • infection control practices
    • physical environment
    • adminstration
  17. OBRA
    • was designed to improve the care of those in the nursing home
    • five star rating system for consumers
    • health inspections
    • staffing
    • quality measures
    • - different clinical and physical measures
    • - pressure ulcers
    • - pain
    • - changes in mobility
    • - falls
    • - uti
    • -¬† long term urinary catheters
    • - inc w/adl's assistance
    • - physical restraints
  18. Bill of rights for long term care residents OBRA
    • voice grieveness and have rectified them
    • information re health condition and tx
    • choose healthcare provider and able to speak private
    • consent and refuse care of treatment
    • manage finances
    • transfer or discharge only for appriariate reason
    • free from abuse
    • free from restraint (safety excluded)
    • privacy and confidentiality
    • treated with dignity consideration and respect
    • immediate vistation and access for family, health care providers and legal advisors, reasonable access for all others
  19. Nurses role in pt's rights
    • pt must be told of rights on admission
    • pt misunderstand their rights
    • nurses are responsible for upholding rights during pt's care
    • pts have the right to refuse care and tx
    • inform pts of potential complications w/out treatment
    • if pt refuses treatment they must sign a document that they understand the risk involved with refusing, notify the HCP
  20. long term care ombudsman program
    • advocates for nursing homes, board and care homes, assisted living and similar adult facilities
    • they work to:
    • - resolve problems of individual residents
    • - bring about changes at the local, state and national levels that will improve residents care and quality of life
    • side bar: families can check to see if a nursing home is good by going to CMS
  21. Principle of cultural change
    the reason to change
    • staff empowerment
    • residents involved in decision making
    • individualized rather than routine task oriented care
    • relationship building
    • sense of community belonging
    • meaningful activites
    • home like environment
    • incr attention to respect staff and the value of culture change
  22. transitional care
    • Moving the pt from one health care practitioner or setting to another for a variety of reasons can results inL
    • - rehospitalization
    • - infections
    • - new diagnoses
    • - relapses
  23. Nursing implications for transition outcome
    • clear communication and instructions
    • complete transfer/discharge info with interdisciplinary team
    • educate pt and families:
    • - med reconcilation
    • - family caregiver education
    • caregiver involvement during transitions
    • sensitivity to cultural/racial considerations
  24. Relocation stress
    • relocation is a major stress of the adult client and family
    • characteristics include:
    • anxiety
    • insecurity alerted mental statistics (confused)
    • depression
    • insecurity
    • loss of control
    • physical problems
    • long term is probably the most stressful
  25. ?
  26. relocation stress syndrome Nx Dx
    • a physiological or a physiological disturbance resulting from the move to and new environment
    • a greater risk:
    • - multiple medical problems
    • - depression or other mental conditions
    • - isolated elders
    • - non english speaking individual
    • - low income individuals
  27. nursing considerations for coping with relocation stress
    • individual must have some control over their environment
    • client must prepare for his or her new situation- help reduce stress
    • nurses closely assess and monitor the client stress
    • be sure to allow for the client's familar and treasure items
  28. Nursing Assessment
    • pt functioning within 6 weeks of the move
    • - better worst same as prior to move?
    • who idea was it for the relocation?
    • - did pt have any control over the decision
    • did the pt have a chance to see the new facilities
    • important items from home
    • orientation to surroundings
    • adequate privacy
  29. Financing Healthcare
    • Affordable care act- obama care for all
    • social security 1935
    • medicare 1965
    • medicaid
    • care for veterans
    • - tricare
    • long term insurance
  30. Affordable Care Act
    • Title I quality affordable health care for all americans
    • Title IV prevention of chronic disease and improving public health
    • Title VIII community living assistance services and supports act (CLASS)
  31. Basics of health care and financing
    • Social security
    • - is design as a pay as you go system
    • - is an age entitlement program
    • - age in eligibility has incre over time: 65 for full benefits, born after 1960= 67 yrs
    • Supplemental security income
    • - social security is not adequate (to help very low income seniors
  32. Medicare
    • healthcare cost continue to rise as people live longer and technology increases
    • Med A: offers acute or short term rehab (copays/deductible)
    • med: covers cost provided by physician, practitioner, outpt services, health care screenings with no minimum copays
    • Med: offers medicare advantage...recieve care from PPO (HMO higher fees)
    • Med D: offers optional prescription coverage. has a deductible you have to pay out of pocket75% coverage
  33. manage care plans
    • PPO/HMO
    • consumer enrolls
    • additional monthly premiums
    • must see provider in network to avoid cost
    • preventative medicine, comprehensive care and regular physical exams are emphasis
  34. Medicaid
    • program funded jointly by federal govt and state govt
    • - eligilibility determined by state
    • provides care for those with low income
    • covers more services than medicare
  35. Care for veterans
    • Veterans Administration System is a model for the continuity of care in various care provider systems
    • active duty and retired miltary members and their dependents are eligible
    • VA hospitals have restrictions; the problem have to be service related
    • financial support "Aid and Attendance pension" is provided
  36. other VA services
    • Tricare health care program
    • - health care insurance program provided by the department of defense for eligible beneficiaries
    • - covers expenses not covered by medicare
    • long term care insurance
  37. Implication  for gerontoligical nursing and healthy aging finances
    case v care manager icmp
    • nurses must advocate for the best, most cost effective care possible
    • Case v. Care manager
    • - overlap in responsiblities- advocate, leader, manager, counselor, negotiator etc.
    • - care managers follow clients thru the continuum of care, are experts in the community resources, make referrals, and are paid privately
    • a multidisciplinary team approach is used to care for the older adults (pcp, rehab, social services, nursing, case manager etc)
    • nurses influences outcomes and ensure the quality care
  38. Goal of elder living
    • to live independently and adapt their environment (home and community) to meet their needs
    • elder prefer to age in place
    • with aging and decreased function= incre need for assistance
  39. Collaboration with the healthcare team
    • the goal is to work for the interprofessional team to address client care issues and healthcare decision
    • collaboration is key compontent among all levels of care
    • the team may exhibit various decision making style
    • decisive: the team uses minium data and one option is generated
    • flexible: the team uses limited amount of data and generates several options
    • heirarchical: team uses a large amount of data and generates one option (centralized and decentralized)
    • intergrative: the team uses a large amount of data and generates several option
    • pt should know there are options based on their needs
  40. collaboration with the interprofessional team
    • recoginizing that working together is the best solution
    • show mutual respect
    • care planning meeting occur between them, client and family members
    • nurse role:
    • - communicate and coordinator
    • - holistic understanding of the client for decision making critical thinking of the developement of the best plan for pt
    • - assertiveness and leadership skills when advocating for the pt
  41. Nurse as a case manager- icmp
    • usually not do provide direct pt care
    • coordinates community resources and services to deliver care to a residential setting
    • enhance the quality of care provided
    • advocate for client and families
    • limit unnecessary cost and lengthy stays
    • facilitate continiuty of care
  42. nurses role during transfers
    • maintain continuity of care among health care providers
    • provide a verbal and written report (page 2)
    • include pt and family members in decision making
    • do they need special equipment for transfer
    • does the pt have advance directives/healthcare proxy?
  43. nurse role
    • documentation:
    • assess data
    • graphic sheets v flowsheets, nurses notes- identify any issues
    • summaries for quick reference- last set of vs
    • nursing care plans
    • communication
  44. AMA (against medical advice)
    • a legal component adult has the right to lean the facility at any time
    • the nurse should make every attempt to explain the risk of leaving
    • nurse should notify the physician and supervisor
    • documentation:
    • - pt needs to sign AMA
    • a nurse can not prevent a pt from leaving if competent legal ramification assault battery, and false imprisonment
  45. Advocacy in gerontological nursing
    • as a nurse we are advocating and assisting clients with:
    • - end of life decisions
    • - access to health care
    • - protection of privacy
    • - informed consent
    • - substandard practices
    • - legislation to promote public policies to support elders
Card Set:
caring for the elders and their caregivers
2015-05-31 17:17:58

second class
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